Association of psychosocial work characteristics with low back pain outcomes

Biomaterials and Cell-Based Regenerative Therapies for Intervertebral Disc Degeneration with a Focus on Biological and Biomechanical Functional Repair: Targeting Treatments for Disc Herniation

Intervertebral disc (IVD) degeneration is a common cause of low back pain and most spinal disorders. As IVD degeneration is a major obstacle to the healthy life of so many individuals, it is a major issue that needs to be overcome. Currently, there is no clinical treatment for the regeneration of degenerated IVDs. However, recent advances in regenerative medicine and tissue engineering suggest the potential of cell-based and/or biomaterial-based IVD regeneration therapies. These treatments may be indicated for patients with IVDs in the intermediate degenerative stage, a point where the number of viable cells decreases, and the structural integrity of the disc begins to collapse. However, there are many biological, biomechanical, and clinical challenges that must be overcome before the clinical application of these IVD regeneration therapies can be realized. This review summarizes the basic research and clinical trials literature on cell-based and biomaterial-based IVD regenerative therapies and outlines the important role of these strategies in regenerative treatment for IVD degenerative diseases, especially disc herniation.

Can Patient Expectations of Returning to Work Documented Before, During, or at the End of Treatment Predict Actual Return to Work Post-treatment? An Evidence-Based Structured Systematic Review

BACKGROUND

There is significant evidence that patient expectations can impact their treatment outcomes. The hypothesis of this systematic review was then the following. There will be significant consistent evidence as specified by the Agency for Health Care Policy and Research (AHCPR) guidelines that chronic pain patient (CPP) expectations for returning to work documented before, during, or at the end of treatment will predict actual return to work post-treatment.

METHODS

Of 316 references, 12 studies fulfilled inclusion criteria. These studies analyzed expectations of returning to work documented before, during, or at the end of treatment and utilized these for predicting return to work post-treatment. Relevant aspects of these studies were abstracted into tabular form for numerical analysis. All studies were rated independently by two reviewers for quality. The percentage of the 12 studies supporting the hypothesis was determined. This was then utilized to determine an AHCPR guideline rating for consistency.

RESULTS

No studies had a rejection quality score. All studies were type 4. The hypothesis was supported by 91.6% of the studies. According to the AHCPR guidelines, this translated into an A rating: consistent findings from multiple type 4 studies.

CONCLUSIONS

CPP expectations of returning to work as documented before, during, or at the end of treatment may predict actual return to work post-treatment.

The impact of family and work-related social support on musculoskeletal injury outcomes: a systematic review

PURPOSE

Social support has been identified as a key factor in facilitating better health outcomes following injury. However, there is limited research on the role of social support in recovery from musculoskeletal injury (MSI), the leading cause of morbidity and disability in the world. The aim of this study is to review the extent to which family and work-related social support (e.g. co-workers, supervisors) has been identified as a factor in the outcomes (physical, psychological, economic) of individuals with MSI.

METHODS

Eight online databases were searched for observational studies reporting findings on family and work-related social support in populations with MSI. Data extraction, quality assessment and a systematic critical synthesis were carried out on included studies.

RESULTS

Fourteen relevant articles were identified. The majority of the studies focused on social support from co-workers or supervisors (n = 11), while three studies focused on social support from the family. Overall, the evidence for the relation between work-related support and MSI outcomes was inconclusive. Similarly, there was limited and inconclusive evidence to demonstrate a relationship between family support and MSI outcomes.

CONCLUSIONS

The results of this review are inconclusive. Further research is needed to understand the role of social support in rehabilitation efforts following MSI. Recommendations for future research are provided.

Absenteeism for low back pain in the municipal administration of Goiânia in the years 2008 and 2009

Objective To establish and evaluate the indicators of absenteeism for low back pain among municipal public servants of the city of Goiania in 2008 and 2009. Material and methods This is a descriptive, epidemiological, retrospective study. We used secondary data provided by the Municipal Medical Board of Goiânia. The sample was composed by active, statutory and commissioned civil servants of the executive branch, of both sexes, who took sick leaves for health care in the period from January 2008 to December 2009. We analyzed all cases of sick leave for health care which were taken for a period of more than 3 days and caused by low back pain. Frequency and severity indexes, proportion of lost time and average length of absences were calculated. The data were statistically analyzed using descriptive and inferential statistics. Results 625 sick leaves were analyzed. In 2008, 32% of public servants took sick leave for health care. 2.83% of these leaves were for low back pain, generating 3541 days of absence. In 2009, the total percentage of sick leaves was 30%. 5.38% of these were due to low back pain, leading to 6890 lost working days. The indicators of absenteeism for 2008 and 2009 were, respectively: frequency index = 0.009 and 0.015; severity index = 0.14 and 0.26, proportion of lost time = 13.89% and 27.34%; average length of absences = 16.39 and 16.84 days. Conclusion The results indicate the need for the creation of intervention policies on work organization, since low back pain is a disorder that can be prevented at the primary level.

Fear-avoidance beliefs associated with perceived psychological and social factors at work among patients with neck and back pain: a cross-sectional multicentre study

Background

Neck and back pain are common and often account for absenteeism at work. Factors at work as well as fear–avoidance beliefs may influence sick-leave in these patients. The aims of this study were to assess: (1) how sick-listed patients in specialised care perceive demand, control, support, effort, reward, and overcommitment at work compared to a general reference group of workers; (2) if women and men report demand, control, support, effort, reward, and overcommitment differently; and (3) the association between psychological and social factors at work and fear–avoidance beliefs about work.

Methods

A cross-sectional multicentre study was carried out in 373 patients on sick leave due to neck and back pain. Psychosocial work factors were measured by demand, control, and support, (Nordic Questionnaire for Psychological and Social Factors at Work), and effort, reward and overcommitment (Effort Reward Imbalance Questionnaire). Fear avoidance beliefs about work were measured by the Fear–Avoidance Belief Questionnaire Work subscale (FABQ-W).

Results

Although the patients differed significantly from a reference working group regarding several subscales of demand, control, support, effort, reward, and overcommitment, the magnitude of these differences were small. The study population also reported significantly higher scores for ‘demand for physical endurance’ than the reference population, and Cohen’s d = 0.55 here indicated a medium degree of difference. Female patients reported significantly higher on support, whereas male patients reported significantly higher demand for physical endurance, quantitative demand, effort, and overcommitment. Demand for physical endurance, job control, job support, high reward, and overcommitment were significantly associated with FABQ-W.

Conclusions

Perceived psychological and social factors at work were strongly associated with fear–avoidance beliefs about work in sick-listed neck and back patients. The demand for physical endurance, control, support, high reward, as well as overcommittment at work outweighed pain and added to the burden of emotional distress and disability regarding fear–avoidance beliefs.

The influence of employment social support for risk and prognosis in nonspecific back pain: a systematic review and critical synthesis

Purpose

To examine the influence of employment social support type (e.g. co-worker, supervisor, general support) on risk of occurrence of low back pain, and prognosis (e.g. recovery, return to work status) for those who have low back pain.

Methods

Systematic search of seven databases (MEDLINE, Embase, PsychINFO, CINAHL, IBSS, AMED and BNI) for prospective or case–control studies reporting findings on employment social support in populations with nonspecific back pain. Data extraction and quality assessment were carried out on included studies. A systematic critical synthesis was carried out on extracted data.

Results

Thirty-two articles were included that describe 46 findings on the effect of employment social support on risk of and prognosis of back pain. Findings show that there is no effect of co-worker, supervisor or general work support on risk of new onset back pain. Weak effects of employment support were found for recovery and return to work outcomes; greater levels of co-worker support and general work support were found to be associated with less time to recovery or return to work.

Conclusions

The evidence suggests that the association between employment support and prognosis may be subject to influence from wider concepts related to the employment context. This review discusses these wider issues and offers directions for future research.

Caspase 3 as a therapeutic target for regulation of intervertebral disc degeneration in rabbits

OBJECTIVE

Although the etiology of intervertebral disc degeneration is poorly understood, one possible approach for its regulation is apoptosis inhibition. This study was undertaken to investigate the antiapoptotic effects of caspase 3 in intervertebral disc degeneration in rabbits.

METHODS

We investigated the effects of caspase 3 small interfering RNA (siRNA) on rabbit nucleus pulposus cells in a serum-starved medium. The effects of direct injection of Alexa Fluor 555-labeled caspase 3 siRNA into the intervertebral disc were also determined in vivo using the rabbit anular needle puncture model.

RESULTS

Rabbit nucleus pulposus cells transfected with caspase 3 siRNA showed a significant decrease in serum-starved apoptotic cells. After local injection of caspase 3 siRNA into intervertebral discs, red fluorescence was observed in the nucleus pulposus upon treatment with Alexa Fluor 555-labeled caspase 3 siRNA. Caspase 3 messenger RNA and protein were down-regulated in the caspase 3 siRNA group. Magnetic resonance imaging and histologic evaluation showed that degenerative changes were significantly suppressed in the caspase 3 siRNA group 4 and 8 weeks after injection. Quantification of TUNEL staining showed that the caspase 3 siRNA group had significantly fewer apoptotic nucleus pulposus cells than the control siRNA group.

CONCLUSION

Our findings indicate that caspase 3 knockdown in rabbit intervertebral disc cells is effective in preventing apoptotic cell death, thus regulating intervertebral disc degeneration.

The effect of recalled previous work environment on return to work after a rehabilitation program including vocational aspects for trauma patients

INTRODUCTION

The aim of the present study was to assess the association between remembered previous work place environment and return to work (RTW) after hospitalisation in a rehabilitation hospital.

METHODS

A cohort of 291 orthopedic trauma patients discharged from hospital between 15 December 2004 and 31 December 2005 was included in a study addressing quality of life and work-related questions. Remembered previous work environment was measured by Karasek's 31-item Job Content Questionnaire (JCQ), given to the patients during hospitalisation. Post-hospitalisation work status was assessed 3 months, 1, and 2 years after discharge, using a questionnaire sent to the ex-patients. Logistic regression models were used to test the role of four JCQ variables on RTW at each time point while controlling for relevant confounders.

RESULTS

Subjects perceiving a higher physical demand were less likely to return to work 1 year after hospital discharge. Social support at work was positively associated with RTW at all time points. A high job strain appeared to be positively associated with RTW 1 year after rehabilitation, with limitations due to large confidence intervals.

CONCLUSIONS

Perceptions of previous work environment may influence the probability of RTW. In a rehabilitation setting, efforts should be made to assess those perceptions and, if needed, interventions to modify them should be applied.

How is recovery from low back pain measured? A systematic review of the literature

Recovery is commonly used as an outcome measure in low back pain (LBP) research. There is, however, no accepted definition of what recovery involves or guidance as to how it should be measured. The objective of the study was designed to appraise the LBP literature from the last 10 years to review the methods used to measure recovery. The research design includes electronic searches of Medline, EMBASE, CINAHL, Cochrane database of clinical trials and PEDro from the beginning of 1999 to December 2008. All prospective studies of subjects with non-specific LBP that measured recovery as an outcome were included. The way in which recovery was measured was extracted and categorised according to the domain used to assess recovery. Eighty-two included studies used 66 different measures of recovery. Fifty-nine of the measures did not appear in more than one study. Seventeen measures used pain as a proxy for recovery, seven used disability or function and seventeen were based on a combination of two or more constructs. There were nine single-item recovery rating scales. Eleven studies used a global change scale that included an anchor of 'completely recovered'. Three measures used return to work as the recovery criterion, two used time to insurance claim closure and six used physical performance. In conclusion, almost every study that measured recovery from LBP in the last 10 years did so differently. This lack of consistency makes interpretation and comparison of the LBP literature problematic. It is likely that the failure to use a standardised measure of recovery is due to the absence of an established definition, and highlights the need for such a definition in back pain research.